The role of the economic evaluation in the

RENEWING HEALTH Project

Bilbao, 27th June 2012

Silvia Mancin Arsenàl.IT

Veneto’s Research Centre for eHealth innovation

Background

The overall background of the project is a number of EU conferences and reports describing

telemonitoring and the potential benefits of a wider use of telemedicine applications in Europe.

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Why telemonitoring is not widely diffused in health systems?

Possible reasons

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Evidences of contribution to quality of care

Technology

Organizative models

Physician/patients perspective

Legal aspects

Cost/effectiveness

Monies

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RENEWING HEALTH:REgioNs of Europe WorkINg toGether for

HEALTH

• Programme: RENEWING HEALTH is the second Pilot Type A eHealth project funded under the Competitiveness and Innovation Framework Programme CIP ICT PSP (Information and Communications Technologies – Policy Support Programme)

• Project start date: 1st February 2010

• Total budget: 14.000.000 Euros

• EU contribution: 7.000.000 Euros

• European Regions involved: 9

• Patients involved: about 8000

AIM of RENEWING HEALTH

Validating, in real life settings and with a

common rigorous assessment methodology

(MAST), the use of existing Personal Health

Systems for innovative types of Telemedicine

services used to monitor chronic patients

with

Cardiovascular Disease (CVD),

Chronic Obstructive Pulmonary Disease (COPD)

Diabetes

and prepare for their wider

deployment.

Assessment Methodology: MAST

MAST – Model for ASsessment of Telemedicine

New model for assessing the effectiveness and contribution to quality of care of telemedicine

applications

A multi-disciplinary process that summarizes and evaluates information about the medical,

social, economic and ethical issues related to the use of telemedicine in a systematic, unbiased

and robust manner

Cluster 4 COPDShort-term follow-up after hospital discharge

Cluster 3 DiabetesUlcer monitoring

Telemonitoring services

Cluster 1 DiabetesMedium-term health coaching and life-long monitoring

Cluster 2 DiabetesLife-long monitoring

Cluster 5 COPDLife-long monitoring

Cluster 6 CVDMedium-term health coaching and life-long monitoring

Cluster 7 CVDRemote monitoring of Congestive Heart Failure

Cluster 8 CVDRemote monitoring of implantable cardiac devices

Cluster 10 Multi pathologyMonitoring of frail patients with chronic deseases

Elegibility Criteria and Sample Size – Cluster 5

COPD Diagnosis of COPD, GOLD Class III-IV Life expectance > 12 months Patient able to use the equipment provided (alone or

assisted).

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Elegibility Criteria and Sample Size – HF Cluster

7 Age 65 years Discharge from hospital after acute HF in the previous 3 months and EF < 40% or EF >

40% plus BNP > 400 (or plus NT-proBNP>1500) during hospitalisation No comorbidities prevalent on CHF with life expectation < 12 months No myocardial infarction or percutaneous coronary intervention in last 3 months, or

scheduled No coronary artery bypass, valve substitution or correction in last 6 months Patient able to use the equipment provided (alone or assisted) Being on waiting list for heart transplantation Being enrolled in other trial

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10

10

Regional eHealth Centre

Patient’s home

Gateway

Patient

Telemonitoring devices

2

3

4Intervention service

General Practitioner

6

1

Alarm device

5

Regional Centre’s Operator

Family/CaregiverData transmission

Data access through Home Care portal

Alarm management

Contact with the patient

7

Social worker

Veneto Region serviceSpecialist

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Assessment Methodology: MAST- Model for ASsessment of Telemedicine

Rigorous assessment of

TELEMONITORINGSERVICES

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Outcomes

CLUSTER 5 - COPD

Outcomes

CLUSTER 7 – Heart Failure

Enrollment start: October 2011

Enrollment period: 6 months 12 months

Follow up period: 12 months

Final Results: December 2013

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Project timeline

15

Veneto Region COPD Consort

Assessed for elegibility (n=369)

Randomised (n=277)

Excluded (n=92)Not meeting inclusion criteria (n=67)Decline to participate (n=19)Other reasons (n=6)

Allocated to intervention (n=198)Received allocated intervention (n=152)Did not received intervention (n=8)Waiting to receive intervention (n=37)

Allocated to usual care (n=79)

Lost to follow-up (n=3)Discontinued intervention (n=0)

Lost to follow-up (n=5)Discontinued intervention (n=0)

Analysed (n=0)Excluded from analysis (n=0)

Analysed (n=0)Excluded from analysis (n=0)

* 93% of Sample Size updated to 21 May 2012

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Veneto Region HFConsort

Assessed for elegibility (n=163)

Randomised (n=134*)

Excluded (n=29)Not meeting inclusion criteria (n=24)Decline to participate (n=5)Other reasons (n=0)

Allocated to intervention (n=89)Received allocated intervention (n=61)Did not received intervention (n=8)Waiting for receiving intervention (n=20)

Allocated to usual care (n=45)

Lost to follow-up (n=2)Discontinued intervention (n=0)

Lost to follow-up (n=8)Discontinued intervention (n=0)

Analysed (n=0)Excluded from analysis (n=0)

Analysed (n=0)Excluded from analysis (n=0)

*43% of Sample Size update to 21 May 2012

Who is the patient?

Socio-Demographics level

Preliminary Results at baseline

Veneto Preliminary Outcomes:Socio-demographic at baseline

Cluster 5 COPD Life-long monitoring

Veneto Preliminary Outcomes:Socio-demographic at baseline

Cluster 7 Remote monitoring of CHF

Skills with technology

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Are you familiar with using a personal computer (PC)?

Are you familiar with using a mobile phone?

Who is the patient?

Geographical spread

Patients – Cluster 5

Patients’ distance from healthcare structureAverage distance (one way): 9,5 kmAverage travelling time (one way): 15,4 minutes

Patients – Cluster 7

Patients’ distance from healthcare structureAverage distance (one way): 10,1 kmAverage travelling time (one way): 17,5 minutes

Transport used to go to the healthcare structure

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Assessment Methodology: MAST- Model for ASsessment of Telemedicine

Rigorous assessment of

TELEMONITORINGSERVICES

HE

ALT

H T

EC

HN

OLO

GY

A

SS

ES

SM

EN

T

HE

ALT

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EC

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Economic analysis

Perspective

• Broad: takes into account all kinds of resources and benefits

• Aim: assessing the service’s overall cost-effectiveness

• Narrower: adopts the LHA’s point of view

• Aim: assessing the company’s financial return when providing the service

• ICER (Incremental Cost-effectveness ratio)– based on SF-6D’s QALYs

• Cost per clinical event avoided (CEA)

Societal

• Return on Investments (ROI)

• Total cost of intervention• Break even analysis• DRG-rate

Business Case

Outcomes

Describe resources, data collection and level of estimation

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Cost analysis and reporting

Veneto Preliminary Outcomes:Costs at baseline

Cluster 5 COPDLife-long monitoring

Veneto Preliminary Outcomes:Costs at baseline

Cluster 7 CVDRemote monitoring of

CHF

*Rapporto Statistico 2011, Veneto Region

Veneto:demographics

In the Veneto Region*:

• 20% of population is over 65

• 16.5% of the elderly population is at risk of poverty

• 68% of people over 75 years is suffering from at least two chronic degenarative diseases

• 46% prelevance of multiple chronic diseases in the population aged between 65 and 74

• Patients affected by COPD 238.000

• Patients affected by CHF 70.000

Expected Results

Carring out a detailed and rigorous report to be used as a basis for decision

Validating a New model for the assessment of telemedicine services (Health Technology Assessment)

Guidelines for the European Countries on how the european prototypes of telemonitoring services can become Large Scale Pilots.

FROM PILOT TO MARKET

www.renewinghealth.eu

Thank you for your attentionSilvia Mancin

smancin@consorzioarsenal.it